Urology has essentially become endo-urology now-a-days. With the advent of endo-urology; open urological procedures have become less and less common in day to day urological practice.
In endo-urology the use of fluoroscopy is a necessary part. The radiation exposure although in most cases is not direct there is definitely secondary exposure due to radiation scatter phenomenon.
If the operating surgeon is screened for radiation exposure with the thermoluminiscent dosimetry; it has been calculated that the total radiation exposure is not significant. If we assume that urologist on an average performs 50 PCNLs per year then studies have shown that the scatter radiation does not exceed 10 mGy. This amount is less than 2% of permissible annual limits of equivalent dose to the extremities.
Hellavel GO et al...Radiation exposure and the urologist: what are the risks? J Urol 2005
But Medical personnel should be aware of scatter radiation risks and minimize radiation exposure when involved in fluoroscopic screening procedures.Dosage minimizing imaging protocols should be strictly followed:
Using the C-ARM judiciously when needed.
Avoiding continuous C-ARM exposure as far as possible.
use of radiation shield without fail.( it is very common practice not to use the shield in smaller procedures)
thyroid shield ,increased distance from the beam,gloves,glasses,beam collimation , use of mini-C-ARM etc
the thermoluminiscent dosimetry should be used to calculate the scatter radiation exposure regularly to assess the risks
The maximum yearly whole body exposure is around 5000 mrem.( this is the limit for the torso while hands it is 55000 mrem) While 1 hour usage of Fluoroscopy ( unprotected ) is 1100 mrem.So the urologist should employ all the possible startegies- radiation shield, modified drapes,radioprotective gloves to minimize the radiation scatter.
The urologist should be cognizant with the concept of time,distance and shielding to minimize the risk of radiation scatter.